| NPI | 1649412578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 2970) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102-203771) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2022-01-04 |